Gambling and Alcohol Addiction: Case Study

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Table of Contents

Introduction
Decision #1
Decision #2
Decision #3
Conclusion
References

Introduction

Recent developments in our understanding of the brain have revealed that compulsivity and impulsivity share similar neurocircuitry and two characteristics of psychopathology. As a result, compulsions and impulsivity can cause various mental health issues, including but not limited to substance abuse and dependence, aggressiveness, gambling, and eating disorders (Leighty & Ansara, 2019). The psychiatric conditions that have the characteristics of impulsivity and compulsiveness are numerous. Because of this dysfunction in the brain circuit centered on the ventral striatum, impulsivity can be defined as the inability to prevent the commencement of specified acts.

On the other hand, we will focus on the dorsal striatum brain circuit in cases of compulsivity, defined as the inability to stop engaging in particular behaviors once they have begun. Medication for impulsiveness, compulsiveness, and addiction will work by altering the activity of specific brain circuits, hence decreasing the motivation for patients to engage in harmful behaviors like excessive alcohol consumption. Patients of all ages struggle with compulsive behaviors, impulsivity, and addiction; among the symptoms reported by the vast majority of these patients is a tendency to live in the moment without planning for the future. Negative behaviors and potentially harmful outcomes are hallmarks of the disorders that emerge from compulsivity, impulsivity, and addiction (Leighty & Ansara, 2019). Some forms of compulsivity involve behavior, such as when someone feels compelled to engage in a ritual to calm their nerves.

In the case study, Mrs Perez, a Puerto Rican woman of 53, admits to getting high from gambling, prompting her to drink more heavily to maintain her composure. The Puerto Rican woman, now 53 years old, has been fighting alcoholism since she was in her early 20s. Treatments for addiction often come with unwelcome side effects, yet they may be necessary in this case. The length of time the patient has battled alcoholism will have a role in the developed treatment plan.

Decision #1

Naltrexone 380 mg intramuscular injection into the gluteal region every four weeks is my first choice. Since Vivitrol injection has proven to be the most effective drug for treating alcoholism by reducing the patient’s desire to drink, I decided to give it to the Puerto Rican woman, age 53. According to Anton (2018), this can aid patients in cutting back on their alcohol consumption and eventually giving it up entirely. Anton (2018) states that PHNPs should remind patients not to drink alcohol before getting a Vivitrol injection.

First, I opt for a 380 mg intramuscular injection of Naltrexone into the gluteal region once every four weeks. I decided to inject the Puerto Rican woman, age 53, with Vivitrol because it is the most effective medicine for treating alcoholism by lowering the patient’s desire to drink. This, as stated by Anton (2018), can help patients reduce their alcohol intake and ultimately quit drinking. According to Anton (2018), PHNPs should advise patients against consuming alcohol before a Vivitrol injection.

Campral 666 mg orally TID was also not a decision I made for the Puerto Rican woman, aged 53, because it is known to produce severe anxiety and suicidal thoughts in some people. The Puerto Rican woman’s age (53) makes the potential for such severe side effects makes it is unwise to give her this drug. I chose to treat the Puerto Rican woman, age 53, with comorbid addiction by injecting Naltrexone (Vivitrol), 380 mg intramuscularly, in the groin area every four weeks. I hoped that this would help her alcohol addiction to the point where she would drink less or stop drinking altogether after the first month of treatment. Patients who receive Vivitrol injections for alcoholism treatment report feeling less of a need to drink, supporting researchers Leighty and Ansara (2019) claim. This aids the patient in kicking the alcohol habit and remaining sober long after treatment has ended.

My treatment approach for the Puerto Rican woman aged 53 may be affected by ethical considerations, including confidentiality and written information (Bipeta, 2019). Thus, I would spend some time explaining to the patient why I have chosen to inject them with Vivitrol rather than some other available options. The patient would then be more at ease, consenting to therapy. I would also insist that the patient keep all information about her treatment private. Patients’ identities, medical histories, and other sensitive information would never be shared with anybody without their permission.

Decision #2

I went with option two, which involves sending the Puerto Rican woman (now 53) to a counselor for help with her gambling problem. The patient’s primary issue, alcoholism, was effectively managed by the Naltrexone (Vivitrol) injection given in the first decision, so I went with that. Although counseling and group therapy are recommended, there are no FDA-approved therapies for gambling addiction.

Because PMHNPs should never give benzodiazepines to patients with substance misuse difficulties, including alcohol addiction, I did not choose the option to give the patient 5 mg of Valium orally to address her anxiety, as was suggested by Bipeta (2019). This is because benzodiazepine addiction is possible and patients may need increasingly high doses to get therapeutic benefits, including decreased anxiety.

Because of the same considerations that led me to decide against injecting the Puerto Rican man aged 53 with Naltrexone (Vivitrol), I also decided against orally administering 1 milligram of Chantix to him. As recommended by Schmitz, primary care mental health nurses (PMHNPs) should prioritize treating a single addiction in patients struggling with several addictions to reduce the likelihood of undesirable outcomes and treatment discontinuation.

I referred the Puerto Rican women patients to the counselor in the hopes that she would get the support she needed to overcome her gambling and cigarette addiction. Patients who have not smoked in a long time may benefit more from counseling than medicine for smoking cessation, as shown by Gioia and Salducci (2019). The treatment would help the 53-year-old Puerto Rican woman who started smoking more heavily two years ago. At this point, informed permission is the only ethical concern that has the potential to affect my treatment strategy with the patient. To help build trust, I would keep the patient updated on her condition and the reasoning behind any individualized decisions made.

Decision #3

The final option I went with was to have Mrs. Perez talk to her counselor about the problem she was having and to keep going to Gamblers Anonymous meetings. The breakdown of trust between a client and therapist can result in the former giving up on treatment and the latter relapsing, as reported by Choi et al. (2017). Repairing cracks in the client-counselor relationship should be a top priority in counseling. I did not make the selection to urge Mrs. Perez to maintain seeing her existing counselor without communicating her current difficulties with the counselor. According to Choi et al. (2017), breaking a therapeutic alliance might cause the client to abandon therapy or make it to accomplish any progress in therapeutic interactions. I also did not choose to stop taking Vivitrol because stopping after only four weeks is too soon when at least four months of treatment are required to manage alcohol dependence addiction effectively.

My intention in speaking with Mrs. Perez’s comforter was to assist her in kicking her gambling and smoking habits so that she can lead a free life of the negative effects those behaviors have had on her. I would refer the patient to a counselor who adheres to the principle of beneficence because I want to ensure that the patient and her counselor can have a fruitful working relationship.

Conclusion

The Puerto Rican woman, age 53, would benefit greatly from a Naltrexone (Vivitrol) injection of 380 milligrams (mg) given intramuscularly in the gluteal region once every four weeks to cope with her alcohol addiction. Because of the high risk of addiction associated with benzodiazepines like Valium, alternatives such as administering the drug to help reduce the patient’s anxiety during the first month of treatment should be avoided. In the first month of treatment, Mrs. Perez would receive counseling and psychotherapy for her smoking addiction before switching to pharmacological methods. Since the FDA approves no medication to treat gambling addiction, the patient would also benefit from psychotherapy.

References

Anton, R. F. (2018). Naltrexone for the management of alcohol dependence. The New England Journal of Medicine, 359(7), 715–721. Web.

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological Medicine, 41(2), 108–112. Web.

Choi, S. W., Shin, Y. C., Kim, D. J., Choi, J. S., Kim, S., Kim, S. H., & Youn, H. (2017). Treatment modalities for patients with gambling disorder. Annals of General Psychiatry, 16(1), 1-8. Web.

Gioia, G., & Salducci, M. (2019). Medical and legal aspects of telemedicine in ophthalmology. Romanian Journal of Ophthalmology, 63(3), 197.

Leighty, A. E., & Ansara, E. D. (2019). Treatment outcomes of long-acting injectable naltrexone versus oral naltrexone in alcohol use disorder in veterans. Mental Health Clinician, 9(6), 392-396. Web.

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